Predicting the Need for Step-Up Therapy After EUS-Guided Drainage of Pancreatic Fluid Collections With Lumen-Apposing Metal Stents

Vinay Chandrasekhara, Sherif Elhanafi, Andrew C. Storm, Naoki Takahashi, Nam Ju Lee, Michael J. Levy, Karan Kaura, Lillian Wang, Shounak Majumder, Santhi S. Vege, Ryan J. Law, Barham K. Abu Dayyeh

Research output: Contribution to journalArticlepeer-review


Background & Aims: A significant proportion of individuals with pancreatic fluid collections (PFCs) require step-up therapy after endoscopic drainage with lumen-apposing metal stents. The aim of this study is to identify factors associated with PFCs that require step-up therapy. Methods: A retrospective cohort study of patients undergoing endoscopic ultrasound–guided drainage of PFCs with lumen-apposing metal stents from April 2014 to October 2019 at a single center was performed. Step-up therapy included direct endoscopic necrosectomy, additional drainage site (endoscopic or percutaneous), or surgical intervention after the initial drainage procedure. Multivariable logistic regression was performed using a backward stepwise approach with a P ≤ .2 threshold for variable retention to identify factors predictive for the need for step-up therapy. Results: One hundred thirty-six patients were included in the final study cohort, of whom 69 (50.7%) required step-up therapy. Independent predictors of step-up therapy included: collection size measuring ≥10 cm (odds ratio [OR], 8.91; 95% confidence interval [CI], 3.36–23.61), paracolic extension of the PFC (OR, 4.04; 95% CI, 1.60–10.23), and ≥30% solid necrosis (OR, 4.24; 95% CI, 1.48–12.16). In a sensitivity analysis of 81 patients with walled-off necrosis, 51 (63.0%) required step-up therapy. Similarly, factors predictive of the need for step-up therapy for walled-off necrosis included: collection size measuring ≥10 cm (OR, 6.94; 95% CI, 1.76–27.45), paracolic extension of the PFC (OR, 3.79; 95% CI, 1.18–12.14), and ≥30% solid necrosis (OR, 7.10; 95% CI, 1.16–43.48). Conclusions: Half of all patients with PFCs drained with lumen-apposing metal stents required step-up therapy, most commonly direct endoscopic necrosectomy. Individuals with PFCs ≥10 cm in size, paracolic extension, or ≥30% solid necrosis are more likely to require step-up therapy and should be considered for early endoscopic reintervention.

Original languageEnglish (US)
Pages (from-to)2192-2198
Number of pages7
JournalClinical Gastroenterology and Hepatology
Issue number10
StatePublished - Oct 2021


  • Acute Pancreatitis
  • EUS
  • Lumen-Apposing Metal Stents
  • Pseudocyst
  • Walled-Off Necrosis

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


Dive into the research topics of 'Predicting the Need for Step-Up Therapy After EUS-Guided Drainage of Pancreatic Fluid Collections With Lumen-Apposing Metal Stents'. Together they form a unique fingerprint.

Cite this